healthcare reforms and pharmaceuticals lessons from turkey
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Healthcare Reforms and Pharmaceuticals Lessons from Turkey. Prof. Dr. Mehtap Tatar Hacettepe University Faculty of Economics and Administrative Sciences Department of Health Care Management. Agenda. General health care reforms Impact of reforms Reforms in pharmaceutical policies. - PowerPoint PPT PresentationTRANSCRIPT
Healthcare Reforms and Pharmaceuticals
Lessons from Turkey
Prof. Dr. Mehtap TatarHacettepe UniversityFaculty of Economics and Administrative SciencesDepartment of Health Care Management
Agenda
OGeneral health care reforms OImpact of reformsOReforms in pharmaceutical
policies
Health Transformation Program2003 -
OPurchaser-provider splitOFamily practitioner schemeOGeneral health insuranceOHospitals with administrative and
financial autonomy
Extension of private hospital use
2003
Performance based payment
2004
Pilot family practitioner scheme
2005
Extension of Green Card Benefits
Transfer of SSK hospitals
2008
Coverage of population under 18
2010
Extension of family practitioner scheme
2011
Full time and university performance based system
Introduction of GHI
Health campuses
Major reform initiatives
Use of private pharmacies by SSK
Impact of the program
OImproved accessOIncreased share of private
providersOIncreased satisfaction with the
systemOIncreased health expenditures
Improved access
OBefore reforms, among those who felt health care need:• 13% did nothing• 19% used self treatment• 30% used self prescribed medicine (National Health Accounts Household Survey, 2003)
Outpatient visit per person per year
2002 2003 2004 2005 2006 2007 2008 2009012345678
Total MoH PHC MoH Hospital Private University
2,79
7,27
MoH
Increasing share of private providers
2002 2003 2004 2005 2006 2007 2008 200905000000
100000001500000020000000250000003000000035000000400000004500000050000000
4.407.122
47.618.188
Number of outpatient visits to private hospitals
MoH
Increased satisfaction (%)
2003 2004 2005 2006 2007 2008 2009 20103035404550556065707580
39.5
46.9
55.3
52.3
68.5
63.4
65.1
73.1
MoH
Increased health expenditures Health Expenditure/GDP (%)
2000 2001 2002 2003 2004 2005 2006 2007 2008 200933.5
44.5
55.5
66.5
7
4.95.2
5.4 5.3 5.4 5.45.8
6 5.9
6.5
Pharmaceuticals
Pricing of pharmaceuticals OExternal reference pricing
O cheapest of France, Greece, Italy, Portugal, Spain
OPublic priceO Public discount on retail price (currently
41% for originals)OInternal reference pricing
O Cheapest + 10%
External reference pricing
2004
VAT to 8%
2005
Pozitive list
Internal reference pricing cheapest+ 30%
2006
20% co-payment for Green Card
Internal reference pricing cheapest + 22%
2007
Reimbursement commission
2009
Generic price 66% of the original
Major pharmaceutical regulations
2010
Internal reference pricing cheapest + 15%
Global budget2010:14,6 billion TL2011: 15,6 billion TL2012: 16,7 billion TL
2010
32,5% public discount for originals
New GMP regulations
2010
3D Barcode system introduced
2011-?????
Major pharmaceutical regulations
2004 2005 2006 2007 2008 200902468
1012141618
8.9210.06
11.2813.01
14.5216.21
Total pharmaceutical expenditure (billion TL)
www.aifd.org.tr
Performance based payment system
Transfer of SSK Hospitals
Increased use of private hospitals
Extension of Green Card benefits
Coverage of population under 18
Family Practitioners
Health campusesAutonomous hospitals
Issues on the agenda
OHealth Technology Assessment OFurther discountsORational drug useORestrictions on prescriptions
Thank [email protected]
2010
Internal reference
pricing cheapest +
15%
Global BudgetBillion TL 2010: 14.62011: 15.62012: 16.7
2010
32,5%discount for
originals
New GMP regulations
2010
3D Barcode system
introduced
2011 - ???
Major pharmaceutical regulations
Reorganization of the MoH2.11.2011
OTurkish Medicines and Medical Devices AgencyOMarket regulationOMarketing approvalOPricing (pharmacoeconomic analysis
for pricing)
Health Implementation Guideline 5.11.2011
OChanges in public discountsOOriginals without generics 41%OOriginals with generics 28%OGenerics 28%
OInternal reference pricing cheapest + 10%
Points to considerOImpact analysis of reforms is crucial?OWhat are the drivers for increasing
expendituresO Isolated emphasis on spending or
utilization alone can be problematicOWhat is the limit for discounts?OWho will be most affected by
discounts?
Thank [email protected]